Direct Observation of Medication Errors in Critical Care Setting: A Systematic Review.

Medication errors continue to be an issue for the critically ill and are costly to both patients and health care facilities. This article reviews published research about these errors and reports results of observational studies. The types of errors, incidence, and root causes have been considered along with adverse consequences. The implications for bedside practice as a result of this review are fairly straightforward. Medication errors are happening at an alarming rate in the critical care environment, and these errors are preventable. It is imperative that all personnel respect and follow established guidelines and procedural safeguards to ensure flawless drug delivery to patients.

A systematic quality review of high-tech AAC interventions as an evidence-based practice.

Although high-tech augmentative and alternative communication (AAC) is commonly used to teach social-communication skills to people with autism spectrum disorder or intellectual disabilities who have complex communication needs, there is a critical need to evaluate the efficacy of this approach. The aim of this systematic review was to evaluate the quality of single-case experimental design research on the use of high-tech AAC to teach social-communication skills to individuals with autism spectrum disorder or intellectual disabilities who have complex communication needs, to determine if this intervention approach meets the criteria for evidence-based practices as outlined by the What Works Clearinghouse. Additionally, information on the following extended methodological standards is reported on all included studies: participant description, description of setting and materials, interventionist description, baseline and intervention description, maintenance, generalization, procedural integrity, and social validity. The results from 18 multiple-baseline or multiple-probe experiments across 17 studies indicate that using high-tech AAC to teach social-communication skills to individuals with autism spectrum disorder or intellectual disabilities and complex communication needs can be considered an evidence-based practice, although the review of comparison (i.e., alternating treatment) design studies did not indicate that high-tech AAC is significantly better than low-tech AAC.

Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme.

BACKGROUND: Diabetes self-management involves adherence to healthy daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. OBJECTIVE: The objective of our study was to identify and classify barriers to adoption of remote health for management of type 2 diabetes. METHODS: The following 6 electronic databases were searched for articles published from 2010 to 2015: MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier). The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of 2 to review and extract data from identified papers. Information collected included study characteristics, outcomes, dropout rates, technologies used, and barriers identified. RESULTS: A total of 53 publications on 41 studies met the specified criteria. Lack of data accuracy due to input bias (32%, 13/41), limitations on scalability (24%, 10/41), and technology illiteracy (24%, 10/41) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations, whereas limitations on scalability were more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. In total, 40.5% (60/148) of identified barrier instances impeded patient engagement, which is manifest in the large dropout rates cited (up to 57%). CONCLUSIONS: The barriers identified represent major challenges in the design of remote health interventions for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high dropout rates, and new interventions are needed to identify and assist those at the greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financial sustainability.

High-technology augmentative and alternative communication for individuals with intellectual and developmental disabilities and complex communication needs: a meta-analysis.

The use of mobile technology is ubiquitous in modern society and is rapidly increasing in novel use. The use of mobile devices and software applications ("apps") as augmentative and alternative communication (AAC) is rapidly expanding in the community, and this is also reflected in the research literature. This article reports the social-communication outcome results of a meta-analysis of single-case experimental research on the use of high-tech AAC, including mobile devices, by individuals with intellectual and developmental disabilities, including autism spectrum disorder. Following inclusion determination, and excluding studies with poor design quality, raw data from 24 publications were extracted and included 89 A-B phase contrasts. Tau-U nonparametric, non-overlap effect size was used to aggregate the results across all studies for an omnibus and moderator analyses. Kendall's S was calculated for confidence intervals, p-values, and standard error. The omnibus analysis indicated overall low to moderate positive effects on social-communication outcomes for high-tech AAC use by individuals with intellectual and developmental disabilities.

Intrahepatic Persistent Right Umbilical Vein and Associated Outcomes: A Systematic Review of the Literature.

The aim of this study was to provide a comprehensive review of the current data surrounding an intrahepatic persistent right umbilical vein in the fetus, including associated anomalies and outcomes, and to assist practitioners in counseling and management of affected pregnancies. We performed a MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Northern Light database search for articles reporting outcomes on prenatally diagnosed cases of a persistent right umbilical vein. Each article was independently reviewed for eligibility by the investigators. Thereafter, the data were extracted and validated independently by 3 investigators. A total of 322 articles were retrieved, and 16 were included in this systematic review. The overall prevalence of an intrahepatic persistent right umbilical vein was found to be 212 per 166,548 (0.13%). Of the 240 cases of an intrahepatic persistent right umbilical vein identified, 183 (76.3%) were isolated. The remaining cases had a coexisting abnormality, including 19 (7.9%) cardiac, 9 (3.8%) central nervous system, 15 (6.3%) genitourinary, 3 (1.3%) genetic, and 17 (7%) placental/cord (predominantly a single umbilical artery). In summary, a persistent right umbilical vein is commonly an isolated finding but may be associated with a coexisting cardiac defect in 8% of cases. Therefore, consideration should be given to fetal echocardiography in cases of a persistent right umbilical vein.

Evaluation of best practices in the design of online evidence-based practice instructional modules.

OBJECTIVES: The research determined to what extent best practices are being followed by freely available online modules aimed at teaching critical thinking and evidence-based practices (EBPs) in health sciences fields. METHODS: In phase I, an evaluation rubric was created after reviewing the literature. Individual rubric questions were assigned point values and grouped into sections, and the sections weighted. Phase II involved searching Internet platforms to locate online EBP modules, which were screened to determine if they met predetermined criteria for inclusion. Phase III comprised a first evaluation, in which two authors assessed each module, followed by a second evaluation of the top-scoring modules by five representatives from different health sciences units. RESULTS: The rubric's 28 questions were categorized into 4 sections: content, design, interactivity, and usability. After retrieving 170 online modules and closely screening 91, 42 were in the first evaluation and 8 modules were in the second evaluation. Modules in the first evaluation earned, on average, 59% of available points; modules in the second earned an average of 68%. Both evaluations had a moderate level of inter-rater reliability. CONCLUSIONS: The rubric was effective and reliable in evaluating the modules. Most modules followed best practices for content and usability but not for design and interactivity. IMPLICATIONS: By systematically collecting and evaluating instructional modules, the authors found many potentially useful elements for module creation. Also, by reviewing the limitations of the evaluated modules, the authors were able to anticipate and plan ways to overcome potential issues in module design.

Process Evaluations of Diabetes Self-Management Programs: A Systematic Review of the Literature.

OBJECTIVE: To conduct a systematic review of process evaluations (PEs) of diabetes self-management programs (DSMPs). DATA SOURCE: An electronic search using Medline (Ovid), Embase (Ovid), CINAHL (Ensco), Academic Search (Ebsco), and APA PsycInfo (Ebsco). STUDY INCLUSION AND EXCLUSION CRITERIA: Peer-reviewed, empirical quantitative, qualitative, or mixed-method studies were included if they (1) were a traditional, group-based DSMP, (2) involved adults at least 18 years with T1DM or T2DM, (3) were a stand-alone or embedded PE, and (4) published in English. DATA EXTRACTION: The following process evaluation outcomes were extracted: fidelity, dose delivered, dose received, reach, recruitment, retention, and context. Additional items were extracted, (eg, process evaluation type, data collection methods; theories; frameworks or conceptual models used to guide the process evaluation, and etc). DATA SYNTHESIS: Due to heterogeneity across studies, studies were synthesized qualitatively (narratively). RESULTS: Sixty-eight studies (k) in 78 articles (n) (k = 68; n = 78) were included. Most were mixed methods of low quality. Studies were typically integrated into outcome evaluations vs being stand-alone, lacked theoretical approaches to guide them, and incorporated limited outcomes such as dose received, reach, and retention. CONCLUSION: Future research should 1) implement stand-alone theoretically grounded PE studies and 2) provide a shared understanding of standardized guidelines to conduct PEs. This will allow public health practitioners and researchers to assess and compare the quality of different programs to be implemented.

Universal Free School Meals and School and Student Outcomes: A Systematic Review.

Importance: The White House National Strategy on Hunger, Nutrition, and Health included expanding free school meals to all students, regardless of income, which has sparked debate in the United States. Objective: To assess the association between universal free school meals (UFSMs) and school and student outcomes in the United States. Evidence Review: An expert panel-informed protocol was developed to evaluate intervention or cohort studies comparing UFSM programs, such as the Community Eligibility Provision (CEP), with non-UFSM programs in US schools from August 2012 (excluding 2020-2021 due to the COVID-19 pandemic) in peer-reviewed publications or government reports. Outcomes included meal participation rates, attendance, dietary intake and quality, food waste, economic impact, food insecurity, anthropometrics, disciplinary actions, stigma, and shaming. A search of Medline, Econlit, Business Source Ultimate, ERIC, Agricola, Cab Abstracts, and CINAHL was performed in April 2024. Two researchers screened articles for inclusion, extracted data, and assessed risk of bias, using the Risk of Bias in Nonrandomized Studies of Interventions tool, for each included study. Grading of Recommendations, Assessment, Development, and Evaluations was used to assess the certainty of evidence for each outcome. Findings: The search identified 2784 records, with 6 studies included, representing more than 11 000 elementary, middle, and high schools. Nonrandomized intervention studies performed difference-in-difference or rate ratio analysis to investigate CEP participation rates, attendance, anthropometrics, and/or suspensions. CEP was associated with increased lunch (3 studies; moderate certainty) and breakfast (1 study; very low certainty) participation. School attendance was unchanged or improved in schools with CEP compared with schools without UFSM (2 studies; low certainty). CEP was associated with lower obesity prevalence (1 study; very low certainty) and fewer suspensions (1 study; very low certainty). Reasons for downgrading the certainty ratings included indirectness (data not fully representative of the United States) and inconsistency (small number of studies limiting ability to assess consistency). Despite the limitations, the evidence reflected well-designed longitudinal intervention studies appropriate for decision-making. Conclusions and Relevance: In this systematic review, UFSMs were associated with increased meal participation, no or slight improvements in attendance, and decreased obesity prevalence and suspension rates; certainty of evidence was moderate for lunch participation and low or very low for other outcomes. Studies did not report several important outcomes, such as diet quality and food security, suggesting the need for more high-quality research encompassing policy-relevant indicators.

The use of ginger bioactive compounds in pregnancy: an evidence scan and umbrella review of existing meta-analyses.

BACKGROUND: Ginger is a commonly used nonpharmacological treatment for pregnancy-related symptoms including nausea and vomiting, inflammation, and gastrointestinal dysfunction. Determining the efficacy of ginger is particularly important during pregnancy and lactation when maternal and neonatal detrimental effects may be a concern. OBJECTIVE: This evidence scan and umbrella review aimed to assess the extent and quality of the evidence regarding the effectiveness and safety of using dietary preparations of ginger during pregnancy and lactation. METHODS: We searched MEDLINE, Embase, CAB Abstracts, and International Pharmaceutical Abstracts up to December 20th 2023 to identify maternal and neonatal outcomes associated with ginger use during pregnancy or lactation compared to placebo or conventional medicines. Outcomes for which a meta-analysis (MA) of intervention studies was identified were synthesized in an umbrella review. The AMSTAR-2 tool was used to critically appraise the reviews. The percent overlap in primary studies was calculated overall and pairwise for each included MA. Data extracted from each MA included the summary estimate of the effect of ginger, the formulation of the ginger treatment, gestational timepoint at intervention, population enrolled in the study, type of intervention, comparator intervention, and number of study participants. RESULTS: The evidence scan identified 90 articles relevant to ginger use during pregnancy and lactation. Seven MAs of ginger use for treating nausea and vomiting of pregnancy reported 22 independent studies with a 49% study overlap among them. The majority of the MAs found a significant positive effect of ginger on the improvement of nausea in pregnancy compared to placebo, or equivalence to conventional treatments, and no evidence of significant adverse effects. The quality of the MAs ranged from critically low to low. CONCLUSIONS: The evidence suggests that ginger is effective at reducing nausea in pregnancy; however, the included studies contained substantial heterogeneity and were of low quality. STATEMENT OF SIGNIFICANCE: Despite common use of dietary ginger preparations among pregnant populations, recent umbrella reviews of ginger use have not focused on the potential health outcomes of ginger consumption in this vulnerable population.

Making the Critical Appraisal for Summaries of Evidence (CASE) for evidence-based medicine (EBM): critical appraisal of summaries of evidence.

OBJECTIVES: Standards for evaluating evidence-based medicine (EBM) point-of-care (POC) summaries of research are lacking. The authors developed a "Critical Appraisal for Summaries of Evidence" (CASE) worksheet to help assess the evidence in these tools. The authors then evaluated the reliability of the worksheet. METHODS: The CASE worksheet was developed with 10 questions covering specificity, authorship, reviewers, methods, grading, clarity, citations, currency, bias, and relevancy. Two reviewers independently assessed a random selection of 384 EBM POC summaries using the worksheet. The responses of the raters were then compared using a kappa score. RESULTS: The kappa statistic demonstrated an overall moderate agreement (κ = 0.44) between the reviewers using the CASE worksheet for the 384 summaries. The 3 categories of evaluation questions in which the reviewers disagreed most often were citations (κ =  0), bias (κ = 0.11), and currency (κ = -0.18). CONCLUSIONS: The CASE worksheet provided an effective checklist for critically analyzing a treatment summary. While the reviewers agreed on worksheet responses for most questions, variation occurred in how the raters navigated the tool and interpreted some of the questions. Further validation of the form by other groups of users should be investigated.